India using too many powerful antibiotics meant for specific infections: Study, Pg8

Key Highlights:

• India is overusing powerful 'watch' antibiotics while underusing first-line 'access' and last-resort 'reserve' drugs, according to a study in The Lancet Public Health.
• The study estimates India's actual antibiotic consumption at 18.3 Defined Daily Doses (DID) per 1,000 people per day, exceeding the ideal requirement of 14.7 DID.
• Only 27% of India's antibiotic use comes from the 'access' category, significantly lower than the estimated ideal of 52.3%.
• The National Centre for Disease Control's (NCDC) 2021-22 survey found 55% of hospital prescriptions were for 'watch' antibiotics, with only 6% based on microbiological evidence.

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Detailed Insights:

• Professor Ramanan Laxminarayan of One Health Trust highlighted that some patients are unnecessarily exposed to 'watch' antibiotics, while others lack access to appropriate medicines.
• Globally, nearly three-fourths of countries overuse antibiotics, contributing significantly to Antimicrobial Resistance (AMR).
• India's higher burden of infectious diseases and AMR legitimately requires more 'watch' antibiotics than many nations, but current usage is still imbalanced.
• Despite the high resistance burden, 'reserve' antibiotics are underused, and antibiotics no longer recommended are still frequently prescribed.
• The NCDC survey revealed that 3 out of 4 hospitalized patients received antibiotics, with 55% of prescriptions being for prophylaxis rather than treatment.
• Dr. Kamini Walia of ICMR noted issues like duplicate antibiotic coverage and extensive use of injectable antibiotics (86.5% administered intravenously).
• She emphasized the need to reduce unnecessary use of common 'watch' antibiotics through better Antimicrobial Stewardship (AMS) and awareness.
• Reserve antibiotics should be strictly limited to patients with documented or strongly suspected multidrug-resistant infections.

Key Concepts Involved:

• Access Antibiotics: First-line drugs for common infections, with a lower risk of resistance development.
• Watch Antibiotics: Broader-spectrum drugs for specific infections, requiring careful use to prevent resistance.
• Reserve Antibiotics: Last-resort drugs for multidrug-resistant infections, to be used sparingly.
• Antimicrobial Resistance (AMR): Microorganisms evolving to resist drugs designed to kill them, making treatments ineffective.
• Antimicrobial Stewardship (AMS): Coordinated programs promoting appropriate antibiotic use to improve patient outcomes and reduce resistance.
• Defined Daily Doses (DID): A statistical measure of drug consumption, representing the assumed average maintenance dose per day.